Trainwreck-Proofing Your Plans

Nearly everyone in employee benefits can immediately think of one. Maybe they call it a “high-cost claimant.” Or perhaps they think of it as a “trainwreck” case. Either way, the member faced a tough health situation—likely a significant diagnosis, a series of complications, a long-road to recovery and life-changing circumstances. Not only that, but the member and the employer also faced a jaw-dropping bill on the backend.

We recently evaluated claims data for a 400-employee company that reflected the experience of many companies. The details:

  • $2M in annual healthcare spend
  • $900K spent on chronic condition management (e.g., high blood pressure, high cholesterol, diabetes) for ~ half of the employee base
  • $700K spent on 8 cancer cases

In other words,

  • 45% of the dollars were spent on 50% of the employees
  • 35% of the dollars were spent on 2% of the employees

With numbers like that, you can see why a recent national survey of employers showed 4 out of 5 of companies rate managing high-cost claims as important/very important to their strategic priorities.

Where Should Employers Focus?

But where should employers focus to prevent, or at least significantly reduce, the negative human and financial impact of these trainwreck cases?

There are two broad categories where employers have historically focused:

  1. Wellness programs to proactively help prevent future high-cost situations
  2. More intensive case management programs for folks already on a path toward serious health outcomes

A benefits consultant with whom we spoke recently described wellness programs as “Jello slipping through your fingers.” While wellness programs can make a difference, they often see limited employee engagement, require a lot of employee behavior change and often do not see results for years. By that time, your investment is likely helping another company’s plan, as employees have moved on to new roles and new companies. As such, let’s set aside this strategy for now.

In the area of intensive case management, the success of the strategy comes down to one key factor: how much behavior change is necessary.

A perfectly designed program may fall flat if it requires the member to make lifestyle changes he or she simply isn’t willing or able to make over the long-term.

While there is likely an opportunity for improvement with chronic care programs, employers should not overlook the easier wins. And with that in mind, optimizing surgical care holds a path for an easier win.

An Easy Win: Optimizing Surgical Care

Foundational to care in two high-cost areas—cancer and musculoskeletal care—surgery, specifically a different approach to surgery and recovery, holds great promise for getting ahead of a meaningful percentage of high-cost claims before they start.

You’re probably thinking:

  • Is there REALLY an approach in surgery that’s better than what my employees are typically getting right now?
  • Can we, as the employer, effectively influence the surgery decisions, experiences and results for our employees and covered members?
  • And can we do it in a way that requires minimal disruption and behavior change by employees and covered members?

The answer is an emphatic “YES” to all three questions. There’s a better way — an approach shown to reduce the risk of these types of astronomically expensive cases TODAY (not tomorrow) and help employees get back to their lives and back to work in half the time.

Watch this video to learn more about how Goldfinch’s better approach to surgery and recovery makes sure patients like Amanda are never alone throughout their road to recovery — and significantly less likely to be an outlier case that won’t soon be forgotten.

Protect your people. Protect your plans with Goldfinch Health – a Better Approach to Surgery and Recovery.

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